Streptococcus suis infection and risk factors for death in northern Thailand
Abstract number: O203
Wangsomboonsiri W., Luksananun T., Saksornchai S., Ketwong K., Sungkanuparph S.
Objectives: To describe clinical characteristics of Streptococcus suis infection, a re-emerging zoonotic disease in Northern Thailand, and to determine the risk factors for death of this disease.
Methods: The retrospective cohort study was conducted among patients who were diagnosed culture-confirmed S. suis infection in Sawanpracharak Hospital, a tertiary care centre in Nakornsawan Province, Northern Thailand, between January 2005 and October 2007. The medical records were reviewed and clinical data was extracted. Risk factors for death were determined by multivariate analysis.
Results: There were 66 patients with a mean (SD) age of 52.9 (11.5) years and 68% were male. The most common risk of S. suis infection was eating of unwell-cooked pork or internal organs (87%). Clinical presentations included acute meningitis (52%), sepsis without localised infection (27%), septic shock (12%), endocarditis (8%), and septic arthritis (1%). Hearing loss was observed in 35% and significantly associated with meningitis. Positive cultures of S. suis were recovered from blood (92%) and cerebrospinal fluid (CSF, 73%). All strains were susceptible to penicillin, cefotaxime and levofloxacin. CSF profiles (median values) among patients with meningitis were as follows: white blood cell, 450 cells/mm3; PMN 48%; L 45%; protein 309 mg/dl; glucose 3 mg/dl; and 40% had positive Gram stain. The mortality rate was 17% and 64% of death occurred in the first 24 hours. Patients who died were more likely to have occupational contact with raw pork (p = 0.016), headache (p = 0.021), gastroenteritis (p = 0.008), septic shock (p < 0.001), low platelet (p = 0.025), low serum bicarbonate (p < 0.001), low albumin (p < 0.001), high ALT (p = 0.040), and high total bilirubin (p = 0.001). Multivariate analysis revealed that only occupational contact with raw pork (p = 0.008) and high ALT (p = 0.001) were the only significant risk factors for death.
Conclusion:S. suis infection commonly presented with acute meningitis or sepsis without localised infection. The most common risk of S. suis infection is eating unwell-cooked pork. The risk factors for death are occupational contact with raw pork and high ALT. Education for people in Northern Thailand to eat well-cooked pork and parts and safely contact with raw pork is crucial. Patients who present with high ALT need intensive care and closed monitoring. A prospective interventional study is needed to minimize the incidence of disease and death from S. suis infection.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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